tions sometimes. Alcohol, tobacco, morphine
may produce a high grade of the disease, if their use is abused.

Symptoms.--These are varied. The most prominent symptom is fatigue. The
patient feels so tired and complains of being unable to do any mental
labor. It is almost impossible to put the mind on one subject for any
length of time. There are headache, dizziness, want of sleep, and there is
great depression of spirits; patient is gloomy, irritable in temper with
manifestations of hysteria. Sometimes there are marked symptoms of spinal
trouble. Pain along the spine with spots or areas of tenderness. Pains
simulating rheumatism are present. There is frequently great muscular
weakness, great prostration after the least exertion, and a feeling of
numbness, tingling, and neuralgic pains. In spinal symptoms, there is an
aching pain in the back, or in the back of the neck, which is a quite
constant complaint. Then there are the anxiety symptoms in many cases.
There may be only a fear of impending insanity or of approaching death, or
of apoplexy, in simple cases. More frequently the anxious feeling is
localized somewhere in the body, in the heart region, in the head, in the
abdomen, in the thorax (chest, etc.). In some cases the anxiety becomes
intense. They are so restless they do not know what to do with themselves.
They throw themselves on the bed, complain, and cry, etc. Sometimes the
patients become so desperate they commit suicide. Some patients do not
wish to see anyone. Some patients cannot read, reading wearies them so
much, or they get confused and dizzy and must stop. Some are very
irritable. They complain of everything. Remember they cannot help it,
usually. Some are easily insulted and claim they are misunderstood. The
circulation may be disturbed in some cases. Then there is palpitation of
the heart, irregular and very rapid pulse, pains, and feeling of
oppression around the heart, cold hands, and feet. The heart's action may
be increased by the least excitement and with the fast pulse and
palpitation there are feelings of dizziness and anxiety and such patients
are sure they have organic disease of the heart. No wonder. Flashes of
heat, especially in the head, and transient congestion of the skin are
distressing symptoms. Profuse sweating may occur. In women, especially,
and sometimes in men, the hands and feet are cold, the nose is red or
blue, and the face feels "pinched." Nervous dyspepsia is present in many